Assisted Outpatient Treatment
To file an AOT petition with the Court, please call the 24/7 Allegheny County Information Referral and Emergency Services (IRES) team at 412-350-4456. IRES can answer questions about crisis mental health services, involuntary commitments, and AOT.
To file an AOT petition, download the petition form(PDF, 228KB) and email it to DHS-AOT-IRES@alleghenycounty.us.
Assisted Outpatient Treatment (AOT)
Assisted Outpatient Treatment (AOT) is a civil court process that can require a person with serious mental illness to be clinically assessed for eligibility. If eligible, a qualified treatment professional creates a tailored community-based treatment plan that is monitored by the court for a limited period of time. AOT is offered as one additional option, alongside other behavioral health and crisis-response efforts, to help people engage in care and reduce repeated cycles of hospitalization and involvement with the criminal justice system.
AOT will be offered in Allegheny County effective January 1, 2026. For more information about why Allegheny County decided to offer AOT, how it will work, and how the implementation will be monitored, read the notification of intent(PDF, 543KB) to the state.
Overview
AOT is being offered in response to longstanding concerns from families, providers, and community partners about limited options to support individuals before a person may become a danger to themselves or others. AOT is intended to support engagement in treatment without institutionalization or police involvement, whenever possible, and to strengthen continuity of care in the community.
Each year, more than 5,000 people in Allegheny County are evaluated for involuntary hospitalization. Fewer than half of those people get follow-up outpatient care after a crisis, despite being referred to that care at discharge. Of that population, 20% die within five years, a substantially higher mortality rate than that observed for other commonly studied, vulnerable populations such as jail exiters, shelter enrollees, SNAP recipients, and the general population.
In Allegheny County, no one will be arrested or jailed for not following their treatment plan. Individuals who are subject to a petition for AOT are guaranteed legal defense throughout the process to ensure their rights are protected.
Who May be Considered
Any responsible person may file a petition in Allegheny County. To be eligible for AOT, the following criteria must be met:
- Person is “unlikely to survive safely in the community without supervision, based on clinical determination”
- “Lack of voluntary adherence to treatment for mental illness” and either:
- Nonadherence significant factor in involuntary inpatient hospitalization within past 12 months
- Nonadherence led to serious violent behavior toward self or others, or threats/attempts within past 48 months
- “Unlikely to voluntarily participate” in treatment
- Needs treatment to prevent deterioration into “substantial risk of serious harm”
AOT will be beneficial and utilized for people to:
- Step Down: transition from involuntary inpatient commitment to community treatment
- Step Up: live in the community, decompensate, and receive additional support to prevent hospitalization, incarceration, or further deterioration
- Step Over: be involved with the criminal legal system and who may benefit from a civil (non-criminal) pathway that supports treatment and reduces time in the justice system, when legally and clinically appropriate
AOT Process
Learn how the Allegheny County AOT process works by viewing the flowchart and process description(PDF, 361KB).
Make a Referral
To file an AOT petition with the Court, please call the 24/7 Allegheny County Information Referral and Emergency Services (IRES) team at 412-350-4456. IRES can answer questions about crisis mental health services, involuntary commitments, and AOT.
To file an AOT petition, download the petition form and email it to DHS-AOT-IRES@alleghenycounty.us.
FAQs
What are the differences between an involuntary inpatient commitment and AOT?
| |
Involuntary Hospitalization |
Assisted Outpatient Treatment |
| Who can petition? |
Any responsible person can apply. A county administrator authorizes warrants for emergency examination if reasonable grounds; a doctor or police officer can authorize one without a warrant. |
Any responsible person can file a petition in the Court of Common Pleas. Though not required for a petition to be filed, an evaluation conducted by a psychiatrist or licensed clinical psychologist must be presented to the Court at the time of the hearing. |
| What are the standards/thresholds? |
- Clear and present danger to self and/or others, including a threat of harm to self or others
- Has made a threat to commit suicide or an act of mutilation and has committed acts in furtherance of any such threats within the last 30 days
|
- Clinical determination that the person is unlikely to survive in the community without supervision
- History of refusing voluntary treatment that resulted in recent involuntary hospitalization or violent behavior
- Evidence the person is unlikely to commit to a treatment program
- The need to prevent relapse or deterioration
|
| How long does an order last? |
Cannot exceed 120 hours (five days), though physicians may file petitions to extend the commitment with the Courts:
- 303 order can extend for 20 days
- 304 can extend for 90 days
- 305 can extend for 180 days
|
AOT orders are 90 days (under a 304 petition). Courts may renew an AOT order with an additional hearing if the thresholds are still met. |
Who can start an Assisted Outpatient Treatment petition?
Any responsible person may initiate a petition for Assisted Outpatient Treatment. This includes family members, friends, neighbors, social service providers, mental health clinicians, and others who have direct knowledge of the individual’s situation.
How long does AOT last?
If upheld, an AOT order is issued for 90 days. The court may extend the order if clinical and legal criteria continue to be met.
How is a person notified about an AOT hearing?
The person will be contacted by a member of their treatment team or other trusted professional. Formal notification is provided through a court summons and is not a warrant. The summons includes information about the hearing and the individual’s right to legal representation.
What happens if the treatment plan is not followed?
People cannot be held in contempt of court for not adhering to the plan. The court may schedule review hearings or request changes to the plan to better support engagement. If a person becomes a danger to self or others, existing involuntary commitment petitions may be sought to protect the person and/or the community.
Will law enforcement be used to make someone attend court?
Law enforcement is not used to locate the person, serve the court summons, or ensure attendance in court as part of the AOT process in Allegheny County.
What supports are included beyond clinical treatment?
Treatment plans may include coordination for intensive behavioral health services, prescriptions for indicated medications, and other supports (like housing and employment) that help stabilize recovery in the community. Certified Peer Specialist support is also offered as an additional recovery resource.
People who are subject to an AOT petition are guaranteed legal defense throughout the process.
What is a Certified Peer Specialist and what role do they play with AOT?
A Certified Peer Specialist (CPS) is a person with lived experience of mental health conditions or co-occurring mental health and substance use disorders who has completed state-approved training and certification. Within AOT, a Certified Peer Specialist is offered as an additional, recovery-oriented support. The Certified Peer Specialist helps individuals navigate the AOT process, stay engaged in treatment, and ensure their perspective is heard by the care team. CPS involvement is intended to build trust, reduce isolation, and support long-term engagement in care.
How will AOT be monitored over time?
The Allegheny County monitoring plan includes administrative data monitoring (including equity-focused analyses by demographic groups), treatment plan case reviews, anonymous client feedback, and an advisory group that will review implementation progress during 2026. All findings will be published once available.